Jason Scott Cerkoney, LAT
Individual provider Active NPI Athletic Trainer · Portage, WI
NPI 1891980504 · NPPES record last updated Sep 6, 2007
Key facts
- NPI
- 1891980504
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 2817 New Pinery Rd
Suite 103
Portage, WI 53901-9257 - Phone
- (608) 745-6290
- Fax
- (608) 745-6250
- NPI assigned
- Sep 6, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029802400 | WI | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Divine Savior Healthcare | Past | Accepting new patients | |
| Divine Savior Healthcare | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | WI | Yes |
Addresses
Primary practice location
2817 New Pinery Rd
Suite 103
Portage, WI 53901-9257
Mailing address
2817 New Pinery Rd
Suite 103
Portage, WI 53901-9257
Phone (608) 745-6290
Other providers in Portage, WI
- Heidi Patricia Campion
- Brianna Capesius
- Stacy Marie Carlson
- Todd James Cason
- Robert Vincent Castrovinci
- Diana L Charlebois
- Soumen Chatterjee
- Ericka Chavez
- Charisa Marie Cheek
- City of Portage
All providers in Portage, WI · Athletic Trainer in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.